CMS Price Transparency Data

Total hip replacement

Facility: Adventist Health Tulare

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,243
Cash Discount Price: $134
vs. Medicare Baseline: 0.09x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Adventist Health Tulare is $1,243. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $134. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.09x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$134

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,243

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$13,116.76

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13,116.76 (100%)

Cash / Self-Pay: $134 (1%)

Insurance Median: $1,243 (9%)

Cash: $134 (1% of Medicare)

Ins. Median: $1,243 (9% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $13,116.76 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$599 - $2,575	5%
Ccipa Medi-Cal - All Plans	$599 - $1,489	5%
Healthnet Medi-Cal	$599 - $1,489	5%
Medi-Cal	$599 - $1,489	5%
Upn-United Physcn Ntwrk Mcal Profee Only	$599 - $1,489	5%
Blue Shield Mcare	$1,147	9%
Fhcn Pace Mcr Adv - All Plans	$1,147	9%
Medicare (plans)	$1,147	9%
Tricare	$1,147	9%
UnitedHealthcare	$1,147 - $1,786	9%
Upn-United Physcn Ntwrk Mcr Adv Profee Only-All Ot	$1,147	9%
Aetna	$1,243	9%
Ah Employee Health Plan - All Plans	$1,262	10%
Incentive Hlth - All Plans	$1,262	10%
Hs Interplan-All Plans	$1,434	11%
Cal Forensic Med Grp - All Plans	$1,492	11%
Cigna	$1,654	13%
Healthnet Hmo/Ppo - All Other Plans	$1,672	13%
Blue Shield Epn	$2,104	16%
Blue Shield-All Other Plans	$2,224	17%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $134.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 27130.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Tulare is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 27130.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.